My name is Terri Diaz, I am the co-founder of GPAC, Administrator and Founder of the Breast Implant Illness Florida Support Group with over 5k members, and Facilitator to the Breast Implant Health Summit. I have been in the Breast Implant Illness community for almost 6 years and I just celebrated my 5-year explant anniversary on December 5th.
There is much controversy over proper breast implant removal procedures. There are plastic surgeons who believe in Breast Implant Illness and they believe that performing en bloc/intact capsulectomy is the proper way to remove an implant. There are plastic surgeons who do not believe in BII or capsule removal, even some saying that capsule tissue is "healthy".
In a recent presentation from one particular plastic surgeon, he stated that in his augmentation consultation that if a patient asks him about breast implant illness, he recommends that the patient stays off of social media breast implant illness support groups and they will not experience it. He also spoke about the "Expert" explant surgeons and said if they really wanted to help our community that they should be sharing their expertise.
This presentation prompted me to question, what is the real definition of the term en bloc? How easy is it to perform an en bloc/ intact capsulectomy? Is it as dangerous and difficult as those surgeons say? Is there a lot of bleeding? What exactly does it entail to perform? Why is there so much controversy?
What is the definition of en bloc?
The term en bloc from the Merriam-Webster dictionary is: as a whole: in a mass.
The term en bloc resection from the McGraw-Hill Concise Dictionary of Modern Medicine Oncology is: There section of a large bulky tumor virtually without dissection Surgery EBR is used in certain cancers to remove a primary lesion, the contiguous draining lymph nodes, and everything in between, as in a modified radical mastectomy
The term en bloc definition cosmetically from the Farlex Partner Medical Dictionary is: As commonly used, the surgical removal of a breast implant (or any capsular implant) and the reactive fibrous tissue that develops around it, which may contract and put pressure on the implant. Sample below:
The term capsulectomy definition cosmetically from the Farlex Partner Medical Dictionary is: As commonly used, the surgical removal of a breast implant (or any capsular implant) and there active fibrous tissue that develops around it, which may contract and put pressure on the implant.
There is a lot of confusion in the breast implant illness community of what needs to be performed for a proper explant. En bloc/intact capsulectomy should be the goal. It is not always possible due to the nature of the capsule and how thin it may be for some patients. Total capsulectomy is when the surgeon removes all of the capsule. This means that there may be tears and the capsule comes out in pieces. Sample below:
There are plastic surgeons who believe that there is no science that indicates the necessity to remove implants "en bloc", even stating that "en bloc" capsulectomy can sometimes result in increased patient morbidity and complications including removal of normal wall muscle and lung punctures with no real known added benefit."
Dr. H. Jae Chun, M.D. from Newport Coast Plastic Surgery, a center that focuses entirely on breast implant removal, states that "the technical difficulties associated with this surgery stem from the fact that the capsules surrounding the submuscular implants are always stuck to the underlying rib cage. Dr. Chun has safely performed over four thousand explant surgeries since 1995 without any rib cage complication." He has an educational YouTube channel with a multitude of videos that show exactly how he performs explant surgery. These videos are readily available on his website as well, to anyone who wants to learn his procedures and techniques.
In a recent study published in September 2021, Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients, the conclusion of this study states "in a large cohort of Breast Implant Illness patients, we found that capsular inflammation is significantly associated with silicone and textured implants. Implant removal with capsulectomy can be safely performed in patients with BII with a low complication rate and high patient satisfaction."
Dr. David Rankin, MD is a Cosmetic, Plastic & Reconstructive Surgery Specialist in Jupiter, FL. He has over 23 years of experience in the medical field and he no longer places breast implants, he has been performing only explants since 2018. He states on his website that the en bloc procedure is beneficial for several reasons. First and foremost, removing the capsule and implant intact ensures that the body does not get contaminated by any fluids or material left behind by the implant. Second, it allows the breast tissue and muscle to settle back into their original positions on the chest wall, restoring a normal and natural-looking appearance.
To really see the extent of what it takes to perform breast implant removal surgery, I requested to see if I could view the procedure myself. Dee Hicks, the explant liaison for Dr. Rankin's office made the arrangements for me to watch a breast explant surgery on December 9th, 2021.
Because of Dr. Rankin's expertise and experience, he makes the procedure seem very easy. He delicately removes the capsule from the breast tissue making sure the complete capsule is removed with the implant. With the cauterizing technique, there is no excessive amount of bleeding. He shows me the capsule-free pocket after the removal and educates me on where the pectoralis major and pectoralis minor are. He shows me the location of the ribs and how close the lungs are. I questioned him on how severe the risk is for a pneumothorax while performing this procedure, and he explains that with all surgery there are risks, but if performed properly, the risks are minimal.
In conclusion, although there is controversy, the main focus should be the patients. The plastic surgeons complaining about this surgery and do not believe in it should just focus on the surgeries they feel most comfortable performing. There are many plastic surgeons that do listen to their patients' concerns and will perform to the best of their ability what the patient is requesting. At the end of the day, the patients coming in for breast implant removal requesting en bloc/intact capsulectomy are because they have exhausted all options of why they are so sick, have been to multiple specialists, and just want to feel better. There are thousands of women that have had this exact procedure and do get better. Isn't that what we all want in the end?